Cancer Drugs Face Coverage Challenges in UK, PhRMA Says

July 21, 2014

Drugmakers are facing tougher hurdles in getting new cancer drugs covered in the UK, according to a U.S industry trade group. But some observers and UK government officials counter that the majority of these expensive treatments are still being widely reimbursed, even if they come with some restrictions.

In a recent report, PhRMA said the rate at which the UK’s National Institute for Health and Care Excellence (NICE) rejects cancer medicines has been increasing in recent years.

Last year, for example, the agency rejected all six cancer medicines it reviewed, according to the July 11 PhRMA-sponsored report, written by healthcare information and data analytics firm Context Matters. In 2008, by contrast, NICE recommended rejecting only 33 percent of its oncology drug appraisals, and recommended coverage with restriction in 50 percent of the cases.

Furthermore, the report says, from 2007 through last year, NICE gave 56 percent of the cancer drugs it reviewed a non-coverage recommendation, compared with only 16 percent of non-cancer products.

The report cites NICE’s September 2013 rejection of Pfizer’s lung cancer drug Xalkori (crizotinib) as an example of how the agency’s appraisals “conflict with patient needs and continued medical progress.” Xalkori, which costs roughly $115,000 per year, provides a median gain of 5.1 months in progression-free survival compared with another drug, docetaxel.

A NICE spokesman disputed the study’s conclusions. NICE is prepared to accept higher premiums for cancer treatments than it usually accepts for non-cancer drugs, he said.

“And even when NICE recommends against the routine use of a cancer drug, the NHS in England makes it available anyway,” he said referring to a fund called the Cancer Drugs Fund, which was created in 2011 specifically to pay for cancer treatments in England that either haven’t been reviewed yet or didn’t pass NICE’s cost-effectiveness test.

PhRMA contends the need to establish the fund in the first place demonstrates the restrictiveness of NICE decisions. Many patient groups are fearful that, if the fund does not continue to receive funding, “access to cancer medicines will revert to being the worst in Europe, with more than 16,000 patients a year denied help,” the report says.

Joshua Cohen, Ph.D., a researcher at the Tufts Center for the Study of Drug Development, says that NICE is more flexible than the Context Matters report indicates. Overall, he said, people looking at recent trends in NICE’s reimbursement of cancer drugs shouldn’t draw too negative a conclusion.

“You have to look at it from a relative perspective,” he said. Even though NICE may be covering less than it used to, over the long run, Cohen said, “in the UK, most cancer drugs get approved for reimbursement…and 85 to 90 percent [of drugs] get past the NICE hurdles.” — Lena Freund

Originally appeared in Drug Industry Daily, the pharmaceutical industry’s number one source for regulatory news and information. Click here for more information.